| NPI | 1487603486 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: WV 10527) |
| Additional Taxonomies | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: WV 10527) |
| Enumeration Date | 2006-05-08 |
| Last Update Date | 2025-06-13 |